• The Federal Benefits Open Season begins tomorrow, November 10, and continues through December 8.
• The American Health Information Community (AHIC) holds its final meeting on November 12. AHIC Successor, Inc., “the public-private partnership created to improve the quality of American healthcare through the adoption of interoperable information technology standards,” will hold its inaugural Board of Directors meeting on Thursday, November 13, 2008. AHIC Successor has posted for public comment a report titled “A Process for Establishing Nationwide Health Information Technology Priorities.” Comments are due by November 11.
• The prescription benefits manager Express Scripts announced last week that
  

  it has received a letter from an unknown person or persons trying to extort money from the company by threatening to expose millions of the company’s patients’ records. The letter included personal information of 75 members, including their names, dates of birth, social security numbers, and in some cases, their prescription information. The company said it has notified the affected members. It also immediately notified the FBI, which is investigating the crime. The company also said that it is conducting its own investigation with the help of outside experts in data security and computer forensics. The letter arrived in early October. “We have been conducting a thorough investigation since we received this threat and we are taking it very seriously,” said George Paz, chairman and chief executive officer. “We are cooperating with the FBI and are committed to doing what we can to protect our members’ personal information and to track down the person or persons responsible for this criminal act.”

• According to the Wall Street Journal’s Health Blog, prescription benefit manager Medco’s CEO David Snow predicted last week, following the election, that Congress is likely to enact next year a bill that will create a generic pathway for specialty or biotech drugs. That is good news.
• Speaking of PBM’s, Drug Benefits News reports that “A new pharmacy benefit pilot program involving Caterpillar Inc. and Wal-Mart Stores, Inc. cuts “significant waste” out of the pharmaceutical supply chain and scraps the long-maligned average wholesale price (AWP) discount methodology in favor of an Rx cost-plus model, say those involved in the program. Both Caterpillar and Wal-Mart tell DBN that the program is attracting the attention of other large employers, and has the potential to change the rules of the game of the pharmacy benefit industry.”
• Finally, the New York Times reported last week that Washington University scientists successfully decoded the genome of a woman suffering from leukemia.
  

  This is the first of many of these whole cancer genomes to be sequenced,” said Richard K. Wilson, director of Washington University’s Genome Sequencing Center and the senior author of the study. “They’ll give us a whole bunch of clues about what’s going on in the DNA when cancer starts to bloom.” Dr. Wilson said he hoped that in 5 to 20 years, DNA sequencing for cancer patients would consist of dropping a spot of blood onto a chip that slides into a desktop computer and getting back a report that suggests which drugs will work best for each person.“That’s personalized genomics, personalized medicine in a box,” he said. “It’s holy grail sort of stuff, but I think it’s not out of the realm of possibility.”

• The Federal Times reports that
  

  President-elect Barack Obama said he will expand family leave, flexible work schedule and teleworking benefits to federal employees; roll back controversial pay-for-performance systems; review current outsourcing policies; and give collective-bargaining rights to Transportation Security Administration employees.

  In a series of late-October letters to John Gage, the national president of the American Federation of Government Employees, Obama sounded off on numerous issues and policies. The union released the letters today {November 5].

  Copies of the letters accompany the online article.

• Govexec.com reports that “Federal employee advocates are optimistic that Democrats’ gains in Tuesday’s election will give them a wide opening to repeal Defense Department pay reforms and advance benefits legislation.” On the FEHBP front, Govexec.com says that
  

  Employee groups plan to lobby for legislation that would increase the government’s share of health insurance premiums and for a federal contribution to dental and vision plans. A bill introduced in early 2007 by House Majority Leader Steny Hoyer, D-Md., would have increased the portion of premiums covered by the government from 72 percent to 80 percent, thus reducing the burden on Federal Employees Health Benefits Program enrollees, whose premiums will rise an average of 7 percent in 2009. Beth Moten, legislative director for AFGE, said on Thursday that unions also would push for an overhaul of FEHBP, a program she argues has been run poorly by the Office of Personnel Management. Allowing 9 million current and retired federal employees to enroll in any of 250 plans dilutes their bargaining power with insurance companies, she said. “The national health insurance issue will take priority, so we’re trying to figure out how to dovetail with that,” Moten said. One proposal advanced during the campaign was to set up a program similar to FEHBP for the uninsured. “If they use FEHBP as a parallel program or model, we need to make sure our people are being treated right,” Moten said.

  The FEHB Program was founded almost fifty years ago on the principle of competition among health plans. It has operated successfully ever since. Ms. Moten’s suggestion for “overhauling the FEHB Program” in my view is bad policy.

U.S. News and World Report has published its HMO rankings (commercial, Medicare, and Medicaid) which is based on NCQA data. Harvard Pilgrim Health Care is number 1. 

Ron Davis, MD, immediate past president of the American Medical Association, died yesterday. I was impressed by his courage in carrying out the responsibilities of his office while undergoing treatment for pancreatic cancer.  He educated the public about his treatment through the Carepages website.  He was clearly a man of character. 

As far as I can recall FEHB plan brochures generally have defined a covered hospital as one accredited by JCAHO (“the Joint Commission”).  Until recently, the Joint Commission was the only CMS approved vendor that could accredit hospitals for Medicare participation. The AMA News reports that CMS in May 2008 approved a second vendor, DNV Healthcare.  DNV’s program is known as NIAHO.  What’s more, on October 24, CMS placed one of the Joint Commission’s programs on probation, which the Joint Commission must resolve by May 2009.

The AMA has named November Heal that Claim month. Check out their special website which includes a National Health Insurer report card.

• OPM has launched its new employee benefits website just in time for Open Season which begins on November 10.
• The Leapfrog Group announced that 63% of the 1220 hospitals participating in the Group’s patient safety survey have adopted the Group’s never events policy.
• USA Today reports that Medicare Part D expenses fell by $6 billion in the last federal fiscal year which ended September 30, 2008. According to the paper,
  

  Big reasons for the savings:• Generic drugs. The use of generic drugs has grown sharply, especially among seniors. Norvasc, for high blood pressure, and Fosamax, for osteoporosis, are among expensive drugs now available in generic form. Generics account for 64% of Medicare prescriptions compared with 61% in the private sector, Medicare says. • Fewer enrollees. The program has 2 million fewer participants than originally forecast. Some seniors decided to keep existing drug coverage, Medicare says. Also, fewer poor people enrolled than expected. • Doughnut hole. Seniors have cut costs to avoid falling into the “doughnut hole” — a coverage gap in which drug expenses between $2,510 and $4,050 a year are not insured.

• Speaking of generic drugs, CVS Caremark announced that starting November 9, you can pay $10 for a Health Savings Pass that will allow you to buy a 90-day prescription for one of more than 400 common generic maintenance medications for $9.99 at your local CVS pharmacy. The Pass also provides a 10% discount to cash paying customers at MinuteClinics. CVS is relatively late to the game of offering low cost generics.